******************** APPLICATION FOR GRANGE MEMBERSHIP************************
APPLICATION FOR GRANGE MEMBERSHIP************************Name______________________________________________________________________Street/RFD,
Box_____________________________________________City___________________________State________Zip____________
Phone: Home __________________________ Work _________________________e-mail________________________________
Occupation___________________________________________________________________________________________________
I am at least 12 years old. Birth Date (optional) _____________ _____ _____________
I hereby apply for membership in_____________________________________________Grange, No.__________ I desire to unite with others in elevating and advancing the interest of community life and family values. I understand the Grange is non-denominational and non-partisan. I pledge on my honor to and abide by the laws of my State and Nation, and the rules and regulations of the Grange. I will not propose an improper person for membership, nor will I oppose the admission of anyone solely on the grounds of personal prejudice. I will endeavor to be a true and faithful Grange member. Should I violate this agreement, I may be dropped from membership. I understand that a portion of dues may pay for a subscription to my State Grange's newsletter.
Applicant's Signature_________________________________________________________________Date _____________________
Recommended by_____________________________________________Application Fee $___________Annual Dues $___________